Bioresponsive immune-booster-based prodrug nanogel for cancer immunotherapy

The combination of chemotherapy and immunotherapy motivates a potent immune system by triggering immunogenic cell death (ICD), showing great potential in inhibiting tumor growth and improving the immunosuppressive tumor microenvironment (ITM). However, the therapeutic effectiveness has been restricted by inferior drug bioavailability. Herein, we reported a universal bioresponsive doxorubicin (DOX)-based nanogel to achieve tumor-specific co-delivery of drugs. DOX-based mannose nanogels (DM NGs) was designed and choosed as an example to elucidate the mechanism of combined chemo-immunotherapy. As expected, the DM NGs exhibited prominent micellar stability, selective drug release and prolonged survival time, benefited from the enhanced tumor permeability and prolonged blood circulation. We discovered that the DOX delivered by DM NGs could induce powerful anti-tumor immune response facilitated by promoting ICD. Meanwhile, the released mannose from DM NGs was proved as a powerful and synergetic treatment for breast cancer in vitro and in vivo, via damaging the glucose metabolism in glycolysis and the tricarboxylic acid cycle. Overall, the regulation of tumor microenvironment with DOX-based nanogel is expected to be an effectual candidate strategy to overcome the current limitations of ICD-based immunotherapy, offering a paradigm for the exploitation of immunomodulatory nanomedicines.

Different approaches to revascularization for complex coronary artery disease and left ventricular dysfunction: analysis of perioperative outcomes / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the perioperative outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of complex coronary artery disease and left ventricular dysfunction.</p><p><b>METHDOS</b>The clinical data of 966 patients admitted to our hospital from January 2003 to December 2013 with coronary artery disease and left ventricular dysfunction (ejection fraction ≤50%) were retrospectively reviewed. Among the patients, 386 underwent CABG and 580 received PCI. After matching for EuroSCORE risk factors and preoperative echocardiographic parameters, 135 patients with CABG and 135 with PCI were enrolled in this study. With hospital mortality and perioperative major complications as the endpoints, the early outcomes of the procedures were evaluated. Perioperative echocardiography was performed to evaluate the change of left ventricular geometry and function.</p><p><b>RESULTS</b>Compared with CABG group, PCI group had significantly higher incidences of chronic lung disease (8.1% vs 0.7%, P=0.003) and recent myocardial infarction (64.4% vs 31.9%, P=0.000) but significantly lower left-main disease (12.6% vs 23.7%, P=0.018); the other baseline characteristics were comparable between the two groups. Patients with CABG had a greater number of treated target vessels than those with PCI (2.90±0.81 vs 1.67±0.73, P=0.000), and complete revascularization was more common in CABG group (94.8% vs 51.8%, P=0.000). No significant difference was found in perioperative variations of LVEF between the two groups, but patients with CABG had a greater variation in LVEDD than those with PCI. The hospital mortality and other major complications were similar between the two groups.</p><p><b>CONCLUSION</b>Both CABG and PCI are safe and reliable revascularization strategies for complex coronary artery disease and left ventricular dysfunction, but CABG can achieve a higher rate of complete revascularization and better improves the left ventricular function.</p>

Thrombosis and morphology of plaque rupture using optical coherence tomography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Thrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis.</p><p><b>METHODS</b>We used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded.</p><p><b>RESULTS</b>The fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00 ± 17.00) µm vs. (96.00 ± 48.00) µm; P = 0.0076).</p><p><b>CONCLUSIONS</b>Plaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.</p>

Evaluation of neointimal coverage in patients with coronary artery aneurysm formation after drug-eluting stent implantation by optical coherence tomography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The vessel healing in patients with coronary artery aneurysms (CAA) that form after drug-eluting stent (DES) implantation is not clear. This study aims to assess the vessel healing in patients with CAA formation after DES implanation.</p><p><b>METHODS</b>From June 2008 to August 2011, follow-up coronary angiography was conducted on 1160 patients who underwent percutaneous coronary intervention (PCI). The average period of follow-up was about (18.95 ± 13.05) months. A total of 175 patients who underwent DES implantation into de novo lesions and who underwent coronary angiography and optical coherence tomography (OCT) examination during follow-up were identified. Patients were divided into the CAA group (n = 31) and non-CAA group (n = 144) based on the results of the coronary angiography. The cardiac events including angina and acute myocardial infarction were noted; in addition, the neointimal thickness and the frequency of strut malapposition and strut uncoverage were also noted.</p><p><b>RESULTS</b>A greater proportion of incomplete neointimal coverage (17.17% vs. 1.90%, P < 0.001) and strut malapposition (18.20% vs. 1.38%, P < 0.001) were observed in the CAA group. The neointimal thickness in the CAA group was significantly thinner than that in the non-CAA group ((146.6 ± 94.8) µm vs. (192.5 ± 97.1) µm, P < 0.001), as detected via OCT. Patients with CAA formation had a higher frequency of cardiac events including angina pectoris (25.81% vs. 6.25%, P = 0.001) and acute myocardial infarction (9.68% vs. 0.13%, P = 0.002) and thrombosis (16.13% vs. 0.69%, P < 0.001). The longitudinal length of the CAA in the cardiac event group was significantly longer than in the no cardiac event group ((20.0 ± 9.07) mm vs. (12.05 ± 5.38) mm, P = 0.005).</p><p><b>CONCLUSION</b>CAA formation after DES implantation is frequently associated with cardiac events as a result of stent malapposition and incomplete neointimal coverage.</p>

An initial study on the feasibility of diagnosing myocardial ischemia with CT first-pass myocardial perfusion imaging at rest / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the feasibility and accuracy of CT first-pass myocardial perfusion imaging (CT first-pass MPI) at rest for diagnosis of myocardial ischemia. Results of adenosine-induced myocardial perfusion scintigraphy (MPS) were used as gold standard.</p><p><b>METHODS</b>Twenty-two patients with suspected or diagnosed coronary artery disease (CAD) were included and CT coronary angiography (CTCA) and MPS were performed within 2 weeks. CT first-pass MPI detected myocardial ischemia results through analyzing the raw date of CTCA were compared with MPS results.</p><p><b>RESULTS</b>The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CT first-pass MPI at rest for detecting myocardial ischemia were 92% (12/13), 78% (7/9), 86% (12/14), 88% (7/8) and 86% (19/22), respectively.</p><p><b>CONCLUSION</b>CT first-pass MPI at rest could detect myocardial ischemia with an accuracy similar to that of MPS.</p>

Anticoagulant efficacy and safety of argatroban for patients undergoing elective percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the anticoagulant efficacy and safety of argatroban for patients undergoing elective percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>A total of 300 consecutive patients with coronary heart disease undergoing elective PCI were enrolled and randomized into heparin group (100 U/kg via artery sheaths, n = 150) and argatroban group (200 µg/kg bolus, followed by 350 µg·kg(-1)·h(-1) i.v. infusion, n = 150). The primary efficacy endpoint was the activated clotting time (ACT) results (10 min and 60 min after anticoagulant administration and at the point at the end of PCI). The additional dosage of heparin or argatroban was given if the ACT value during PCI procedure < 250 s. Activated partial thromboplastin time (APTT) was also measured at pre-procedure, 10 min after anticoagulant injection and 60 min after PCI. The primary safety endpoint was thrombosis and hemorrhagic events during PCI procedure and hospital stay.</p><p><b>RESULTS</b>All patients in the two groups attained the target ACT ( ≥ 250 s), and ACT in heparin group was significantly prolonged [(343.32 ± 44.70) s vs. (289.60 ± 20.88) s, P < 0.01], at 10 min after anticoagulation injection. ACT was similar between the two groups at 60 min after anticoagulation injection [(291.26 ± 46.79) s vs. (288.40 ± 21.61) s, P > 0.05]. The ACT value in argatroban group was similar at 10 min and 60 min after injection (P > 0.05). Supplemental anticoagulant was needed for 13 (8.7%) patients in heparin group and 2 (1.3%) patients in argatroban group because of ACT under 250 s (P < 0.05) . At the end of PCI procedure, ACT in heparin group was significantly shorter than in argatroban group [(247.16 ± 41.38)s vs. (278.65 ± 20.51) s, P < 0.01]. APTT in heparin group was significantly prolonged than in argatroban group not only at 10 min point [(182.16 ± 4.37) s vs. (81.69 ± 21.49) s, P < 0.01] after anticoagulant injection but also at the point of 60 min after PCI procedure[(169.13 ± 6.35)s vs. (56.21 ± 15.68) s, P < 0.01]. There was no thrombus event in two groups and no bleeding event in argatroban group, and there was three bleeding events in heparin group [2.0% (3/150) vs.0, P > 0.05].</p><p><b>CONCLUSION</b>Argatroban is an effective and safe anticoagulation agent during elective PCI procedure, anticoagulant efficacy and risk of bleeding side effects of argatroban are similar to heparin.</p>

Optical coherence tomography assessment of edge dissections after drug-eluting stent implantation in coronary artery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography (OCT) to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent (DES) implantation.</p><p><b>METHODS</b>Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study.</p><p><b>RESULTS</b>Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study: (1) superficial intimal tears (n = 3), (2) subintimal dissections (n = 4), (3) split of media (n = 1), (4) disruption of the fibrotic cap of plaque (n = 1). Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections (1.682 ± 0.425 vs. 1.229 ± 0.285, P = 0.0290; 1.507 ± 0.445 vs. 1.174 ± 0.265, P = 0.0072).</p><p><b>CONCLUSIONS</b>The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.</p>

Prevention of restenosis in the canine coronary stents through local delivery of paclitaxel using the double-balloon perfusion catheter / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the safety and efficiency of local paclitaxel delivery using the double-balloon perfusion catheter to prevent restenosis in the canine coronary artery.</p><p><b>METHODS</b>Twenty domestic canines underwent bare-mental stent implantation after balloon injure of the left coronary artery. A novel double-balloon perfusion catheter was used to deliver the drug locally in the canine coronary artery. In the treatment group (n = 15), paclitaxel (10 ml, 20 micromol/L) was delivered using the double-balloon perfusion catheter before stent implantation. In the control group (n = 5), 10 ml saline was delivered using the double-balloon perfusion catheter before stent implantation. The perfusion time in both groups was (26.45 +/- 5.18) s. Animals underwent coronary angiography and optical coherence tomography (OCT) 90 days after stent implantation and were sacrificed. Vessels were perfusion-fixed and morphometric analysis was performed using conventional techniques.</p><p><b>RESULTS</b>Coronary angiography results showed restenosis rate in control group was significantly higher than that in treatment group (60% vs. 33.33%, P < 0.05). The parameters of OCT showed in treatment group and control group: the neointimal thickness was (0.19 +/- 0.08) mm and (0.38 +/- 0.03) mm, the neointimal area was (1.52 +/- 0.49) mm2 and (2.51 +/- 0.47) mm2, the lumen area was (3.50 +/- 0.66) mm2 and (2.78 +/- 0.57) mm2, the extent of stenosis was (30.13 +/- 8.56)% and (47.40 +/- 4.50)%, and all the variances above were significantly different between the two groups (P < 0.05). The histologic parameters showed in treatment group and control group: the neointimal thickness was (0.22 +/- 0.10) mm and (0.47 +/- 0.05) mm, the neointimal area was (1.85 +/- 0.78) mm2 and (3.43 +/- 0.25) mm2, the lumen area was (3.15 +/- 0.43) mm2 and (1.85 +/- 0.55) mm2, the extent of stenosis was (36.00 +/- 10.97)% and (65.40 +/- 8.23)%, and all the variances above were also significantly different between the two groups (P < 0.05). The stents of both the groups were fully endothelialized. No thrombus or aneurysm was found in stents.</p><p><b>CONCLUSION</b>Local delivery of paclitaxel with the double-balloon perfusion catheter to prevent restenosis in coronary stents is safe and efficient.</p>

Ex vivo assessment of coronary lesions by optical coherence tomography and intravascular ultrasound in comparison with histology results / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the diagnostic accuracy of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in the detection of ex vivo coronary plaques with different compositions compared with histology results.</p><p><b>METHODS</b>OCT and IVUS were performed in 15 autopsied heart specimens and the isolated coronary artery was assessed by routine histological processing thereafter. Coronary plaques were classified into 3 types (lipid-rich plaque, calcified plaque and fibrous plaque) according to standard criteria respectively. Sensitivity and specificity for detection of different types of plaque by OCT and IVUS were calculated according histology results.</p><p><b>RESULTS</b>Seventy seven coronary plaques were analyzed. OCT demonstrated a sensitivity and specificity of 69% and 88% for lipid-rich plaque, 93% and 92% for calcified plaque, 88% and 98% for fibrous plaque. IVUS demonstrated a sensitivity and specificity of 61% and 92%, 98% and 97%, 68% and 90% respectively. The agreement between OCT and IVUS in assessment of coronary plaque was 0.831 (Kappa = 0.72, P < 0.01).</p><p><b>CONCLUSIONS</b>Both OCT and IVUS correctly detected ex vivo coronary plaques and there was a good agreement in assessment of coronary plaques between OCT and IVUS. OCT is superior to IVUS in assessment of fibrous plaque and is similar as IVUS in assessment of calcified plaque.</p>

Molecular analysis of TP53, D9S1747, D9S162 and RPS6 in oral squamous cell carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the correlation between the frequency of molecular abnormalities of 4 loci at chromosomal 9p21 (D9S1747, D9S162, RPS6) and 17p13 (TP53) and the clinical characteristics and prognosis.</p><p><b>METHODS</b>The oral squamous cell carcinoma (OSCC) lesions in 71 patients were manually microdessected. Genomic DNA from these lesions and normal lymphnode tissu or peripheral blood of the same patients were extracted using the Watson's tissue kit. The loss of heterozygosity (LOH) and microsatellite instability (MI) of 17p13 and 9p21 were analyzed by PCR-page electrophoresis after DNA extraction.</p><p><b>RESULTS</b>LOH and MI were detected in the OSCC of 48 patients (68%). The LOH and MI frequency at chromosomes 17p13 and 9P21 were 56% (35/63) and 59% (40/68) respectively. The LOH and MI frequency at 9p21 was significantly associated with WHO grading (P < 0.01) and lymphonode metastasis (P < 0.01). The LOH and MI frequency at 17p13 was significantly associated with clinical stage (P < 0.05). TP53 genetic aberration and 9p21 genetic aberration were significant prognostic factors for OSCC. The prognosis was poor in the LOH and MI positive group of chromosome 17p13 and 9p21. The frequency of LOH and MI at TP53 was the only independent factor for overall survival (P < 0.05).</p><p><b>CONCLUSIONS</b>The LOH and MI of 17p13 and 9p21 were related to clinical stage and lymphonode metastasis. LOH of TP53 was an independent prognostic factor for OSCC.</p>

Evaluation on the neointimal coverage post drug-eluting stent implantation by optical coherence tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the neointimal coverage after the implantation of various drug eluting stents (DES) by optical coherence tomography (OCT).</p><p><b>METHODS</b>The study comprised of 62 patients implanted DES for (15.3 ± 5.7) months. Patients were divided into three groups according to the type of implanted stent: Cypher group (patient = 26, stent = 57), Endeavor group (patient = 17, stent = 23) and Firebird group (patient = 19, stent = 32). OCT images of the stent were analyzed by software equipped by Light Lab system. Intimal thickness of 64 µm, 168 µm and 366 µm represents 10%, 25% and 50% lumen area loss, respectively. Neointimal coverage was thin with intimal thickness ≤ 64 µm, satisfactory with intimal thickness between 65 µm and 366 µm and hyperplasia and restenosis with intimal thickness > 366 µm.</p><p><b>RESULTS</b>The percent of complete neointimal coverage was similar among groups (P > 0.05). The thickness of neointimal coverage in Cypher and Endeavor and Firebird group was (178.7 ± 11.9) µm, (228.7 ± 17.1) µm and (170.3 ± 13.3) µm, respectively (all P < 0.05). The symmetry of Cypher stent was better than Firebird stent, and the symmetry of Firebird stent was better than Endeavor stent.</p><p><b>CONCLUSION</b>There was significant difference on neointimal coverage after various types of DES implantation, and OCT can be used to evaluate the symmetry of neointimal coverage post implantation of various DES.</p>

Omeprazole affects clopidogrel efficacy but not ischemic events in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Omeprazole, usually used in the antiplatelet therapy during percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS), has been reported to increase ischemic events in retrospective studies. However, other clinical trials gave paradoxical results. The aim of this study was to assess the effects of omeprazole on clopidogrel efficacy and clinical events.</p><p><b>METHODS</b>All patients (n = 172) received aspirin (loading dose 300 mg and maintenance dose 100 mg/d) and clopidogrel (loading dose 600 mg and maintenance dose 75 mg/d) during the therapy. They were randomized to receive omeprazole (20 mg/d) or placebo for 30 days. Residual platelet activities in the adenosine 5'-diphosphate (ADP) pathway were detected on the fifth day after PCI with thrombelastography (TEG)-mapping. The clinical events were recorded after one month.</p><p><b>RESULTS</b>According to the five levels of platelet activities, the frequency distributions of the inhibition rates were significantly different (P = 0.0062). However, no significant change was seen in the distribution among the highest or the lowest inhibiting levels (> 95% and < 30% inhibition rate). And there were no significant differences (P > 0.05) in events incidence, while gastro-intestinal bleeding decreased in co-administration of omeprazole.</p><p><b>CONCLUSIONS</b>Omeprazole significantly blunts clopidogrel efficacy while not exacerbates ischemic events in ACS undergoing PCI. Omeprazole even can decrease gastro-intestinal bleeding in those patients.</p>

Correlation between acute coronary syndrome classification and multi-detector CT characterization of plaque / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To determine if multi-detector CT (MDCT) characterization of plaque is correlated with the classification of acute coronary syndrome (ACS).</p><p><b>METHODS</b>Altogether 1900 patients were examined by MDCT from December 2007 to May 2009, of whom 95 patients fulfilled the criteria of ACS. Those patients were divided into the discrete plaque group ( n=61) and diffuse plaque group ( n=34) based on the findings in MDCT. The clinical diagnosis of ACS and CT results were analyzed, including segment stenosis score, segment involvement score, 3-vessel plaque score, left main score, calcification score, and remodeling index. The incidences of major adverse cardiac events in follow-up period were also recorded.</p><p><b>RESULTS</b>The patients of the diffuse plaque group were older than those of the discrete plaque group ( Pü0.0001). The diffuse plaque group presented more cases of hypertension, peripheral artery disease, diabetes, and heart failure than discrete plaque group (all P<0.05). All the 5 patients with ST-segment elevation myocardial infarction were found in discrete plaque group. The segment stenosis score of the discrete plaque group was lower than that of the diffuse plaque group(5.15±3.55 vs. 14.91±5.37, Pü0.001). The other four scores demonstrated significant inter-group difference as well (all P<0.05). The remodeling index of thediscrete plaque group was higher (1.12±0.16 vs.0.97±0.20, Pü0.05). Follow-up data showed that major adverse cardiac events occurred more frequently in diffuse plaque group than in discrete group (29.41% vs. 11.48%, P=0.0288).</p><p><b>CONCLUSIONS</b>Characteristics of discrete and diffuse plaques may be significantly different among different classes of ACS. The diffuse plaque may present higher risk, correlated to higher mortality. The diagnosis of discrete and diffuse plaques by MDCT would provide a new insight into the prognosis and treatment of ACS.</p>

CT coronary angiography combined with adenosine stress myocardial perfusion scintigraphy for detecting flow-limiting coronary stenoses / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the feasibility and accuracy of CT coronary angiography (CTCA) combined with adenosine stress myocardial perfusion scintigraphy (MPS) for diagnosis of flow-limiting coronary stenosis.</p><p><b>METHODS</b>A total of 105 patients with suspected or established coronary artery disease (CAD) underwent CTCA and MPS within 4 weeks before invasive coronary angiography. The accuracy of CTCA/MPS in the diagnosis of flow-limiting coronary stenosis was evaluated in comparison with the results of quantitative coronary angiography and MPS.</p><p><b>RESULTS</b>The sensitivity, specificity, positive predictive value and negative predictive value of CTCA/MPS as a combined approach for detection of flow-limiting coronary stenosis were all 100%. In 16% (9/55) of the patients, revascularization procedures were performed and no flow-limiting stenosis was found.</p><p><b>CONCLUSION</b>Combination of CTCA and MPS has an excellent accuracy for detecting flow-limiting coronary stenosis as compared with quantitative coronary angiography/MPI, and can be a useful gatekeeper for revascularization procedures.</p>

Coronary plaque response after drug eluting stent implantation assessed by serial optical coherence tomography analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In general, percutaneous coronary intervention (PCI) relieves vessel stenosis by implantation of a stent, however, the relationship between plaque characteristics and response after stenting is not clear.</p><p><b>METHODS</b>We enrolled 68 patients (68 vessels) with diagnosed unstable angina pectoris that prospectively underwent PCI and an optical coherence tomography (OCT) examination was done before and after stenting. Coronary plaques were classified as fibrous, lipid-rich and calcified plaque according to OCT examination, and fibrous cap thickness, lumen eccentricity, stent expansion, stent malapposition, tissue prolapse, thrombosis, dissection and stent symmetry were noted.</p><p><b>RESULTS</b>The frequency of prolapse was higher in lipid-rich plaques than fibrous plaques (85% vs. 40%, P < 0.001). Dissection most often occurred in fibrous plaque compared with lipid-rich and calcified plaques (60% vs. 32% vs. 29%, P < 0.001). The frequency of stent strut malapposition in calcified plaques was higher than firous and lipid-rich plaques (71% vs. 40% vs. 5%, P < 0.001). In-stent micro-thrombosis was detected only in lipid-rich plaques, with a frequency of 37% (15/41). The risk factors of micro-thrombosis after PCI were cap thickness (OR 0.903, 95%CI 0.829 - 0.985), lumen eccentricity (OR 1.147, 95%CI 1.012 - 1.30), and stent length (OR 1.495, 95%CI 1.032 - 2.166).</p><p><b>CONCLUSION</b>Plaque response after PCI is associated with its characteristics, and of those, micro-thrombosis after stenting in lipid-rich plaques was the most significant finding and can be predicted.</p>

99mTc-MIBI myocardial perfusion image in predicting therapeutic effect of percutaneous coronary intervention / 第二军医大学学报

Objective: To observe the 99mTc-MIBI myocardial perfusion images in patients with myocardial infarction before/after percutaneous coronary intervention (PCI), so as to screen for the reliable predictors for the therapeutic effect of PCI. Methods: Forty-eight patients with myocardial infarction receiving PCI were included in this study. The rest, stress and nitroglycerin myocardial perfusion imaging tests were performed before PCI. The stress and rest myocardial perfusion imaging tests were repeated 1-2 weeks after PCI. The value of (rest 99mTc-MIBI imaging in myocardial perfusion scores after PCI-stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI)/stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI was taken as the curative effect of PCI; the value of(rest 99mTc-MIBI imaging in myocardial perfusion scores before PCI-stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI)/stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI was taken as the functional viable myocardium; the value of (stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI-nitroglycer 99mTc-MIBI imaging in myocardial perfusion scores before PCI)/stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI was taken as potential functional viable myocardium; and the value of(rest 99mTc-MIBI imaging in myocardial perfusion scores before PCI-nitroglycer 99mTc-MIBI imaging in myocardial perfusion scores before PCI)/rest 99mTc-MIBI imaging in myocardial perfusion scores before PCI was taken as drug relative viable myocardium. To screen the proper predictors for therapeutic effects, linear correlation analysis was performed between the curative effect of PCI and the latter 3 factors. Results: Stress and rest myocardial perfusion defects were significantly improved after PCI (P<0.01). Correlation analysis showed that the curative effect of PCI was correlated with the latter 3 factors, with the correlation coefficients being r1=0.63, P<0.01, r2=0.94, P<0.000 1,and r3=0.92, P<0.000 1, respectively,indicating that the potential functional viable myocardium had the best correlationship with PCI. Conclusion: It is necessary to perform the rest, stress and nitroglycerin myocardial perfusion imaging tests in patients with cardiac infarction. The functional viable myocardium is a reliable index in screening the patients suitable for PCI and in predication of the therapeutic effect.

Optical coherence tomography for evaluation of neointimal proliferation after placement of a new drug eluting stent / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate neointimal proliferation following placement of a new drug-eluting stent (BUMA) by optical coherence tomography (OCT).</p><p><b>METHODS</b>Twenty-two patients with coronary artery disease were randomized into BUMA group (n=15) and Endeavor group (n=7) and underwent OCT imaging after 9 months of stent implantation.</p><p><b>RESULTS</b>The neointima hyperplasia (NIH) thickness in BUMA group were significantly smaller than that in endeavor group (0.220-/+0.140 mm vs 0.269-/+0.207 mm, P<0.001), and the uncovered Struts were significantly lower in BUMA group than in Endeavor group (5.65% vs 6.56%, P<0.0001). The luminal late loss in BUMA group was also significantly lower (34.87-/+11.50 vs 40.82-/+18.53, P=0.025).</p><p><b>CONCLUSION</b>BUMA stent is safe and effective for treatment of coronary artery disease.</p>

Correlation of heart and kidney biomarkers to the pathogenesis of cardiorenal syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>The analyze the correlation of heart and kidney biomarkers to different heart and kidney diseases and explore the pathogenesis and classification of cardiorenal syndrome.</p><p><b>METHODS</b>This study involved 841 consecutive patients (600 males and 241 females) admitted between January, 2008 and May, 2008, who underwent NT-ProBNP and creatinine tests during hospitalization. The patients were classified according to the clinical diagnosis at the admission and to the status of the heart and kidney biomarkers.</p><p><b>RESULTS</b>The heart and kidney biomarkers were significantly different between genders. NT-proBNP showed slight elevations in patients with atrial fibrillation, mild non-heart disease, hypertension and angina, but significant elevation in patients with severe non-heart disease. In patients with renal artery stenosis, the heart and kidney biomarkers were moderately increased, which was also seen in patients with diabetes mellitus, myocardial infarction and coronary artery bypass grafting. In dilated cardiomyopathy and rheumatic heart disease, NT-proBNP showed marked increase with only slight increase of creatinine. Patients with chronic kidney disease had the highest NT-proBNP and creatinine levels and the lowest eGFR. The heart and kidneys index increased with the severity of the disease. From Ronco type I to type IV, NT-proBNP rose gradually, but the difference was not statistically significant (P>0.05), and the type I and IV patients had the highest creatinine level; type III involved mainly acute coronary syndrome, heart failure and renal stenosis. According to a modified classification, cardiarenal syndrome was characterized mainly by a marked increase of NT-proBNP, while renalcardiac syndrome by creatinine increases (P<0.05). Acute coronary syndrome, heart failure and renal artery stenosis represented a special entity of cardiorenal syndrome.</p><p><b>CONCLUSIONS</b>Heart and kidney biomarkers and clinical diagnosis are closely related. The heart and kidneys index more accurately reflects the severity of the cardiorenal syndrome. The heart and kidney biomarkers can be used in Ronco classification. The simplified classification is convenient to use and facilitates the clinical decisions of the treatment.</p>

Evaluation of the late stent malposition after drug-eluting stent implantation by optical coherence tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the characteristic of late stent malposition after drug-eluting stent implantation by optical coherence tomography (OCT).</p><p><b>METHODS</b>The study comprised of 32 patients (target vessels: 51, total stents: 71) underwent drug eluting stent implantation one year ago [average (14.8 +/- 5.2) months]. OCT images of the stent were analyzed at interval of 0.5 mm. The stent malposition was detected, the thickness of intima and gap between the stent strut and vessel wall were measured.</p><p><b>RESULTS</b>Stent malposition was detected in 7 patients without clinical cardiac events, including positive remodeling (n = 4), overlapping stents (n = 1) and stent struts covered with thrombus (n = 2). Stent strut apposition with complete intima coverage was about 97.6%, stent struts malposition was 2.4% including half of struts located at the ostium of side branch. The intima coverage of stent struts is similar between the struts at the side branch and others [(0.06 +/- 0.05) mm vs. (0.05 +/- 0.03) mm, P > 0.05].</p><p><b>CONCLUSION</b>The causes of late stent malposition include the primary malposition after stent implantation, positive remodeling, overlapping stents and stent struts located at the ostium of side branch. Thinner intima coverage was also observed on the stent struts with malposition.</p>

Evaluation of neointimal coverage of overlapping sirolimus-eluting stents by optical coherence tomography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although overlapping sirolimus-eluting stents are often used in long lesions during percutaneous coronary intervention, it was not clear how intimal hyperplasia at the overlapping segments compares with that of single-layer sirolimus-eluting stents.</p><p><b>METHODS</b>Optical coherence tomography (OCT) examinations were performed on 22 patients in whom overlapping sirolimus-eluting stents (SESs) were implanted. OCT images were analyzed off-line after the procedure. Still frames were selected and classified, and the length of overlap, lumen loss, and average neointimal thickness on the strut were measured. The stent strut was classified into well-apposed to vessel wall with apparent neointimal coverage (type A), well-apposed to vessel wall without neointimal coverage (type B), malapposed to the vessel wall without neointimal coverage (type C), and strut located at a major side branch (type D).</p><p><b>RESULTS</b>There was no statistically significant difference between strut coverage types within overlapping and non-overlapping segments, but a greater percentage of type C struts were observed within the overlapping segments (5.2% vs 1.4%, P > 0.05). Neither neointimal thickness ((175.0 +/- 59.9) microm vs (168.3 +/- 90.2) microm, P = 0.715) nor lumen loss ((1.61 +/- 0.55) mm(2) vs (1.48 +/- 0.37) mm(2), P = 0.397) was statistically different between the two segments. One patient was diagnosed with suspected in-stent thrombosis at 6 months. Although no specific characteristics of thrombosis were seen on the OCT images, a greater number of malapposed struts without neointima coverage were observed.</p><p><b>CONCLUSIONS</b>About 90% struts were completely covered by neointimal proliferation at 12 months follow-up, and the thicknesses of neointima on overlapping and non-overlapping segments were similar. Most of type C struts at the overlapping segments were found on the inside layer stents. Delayed antiplatelet therapy was beneficial for the patients with incompletely covered struts.</p>